Doctors, Nurses and Health Care Professionals Take Heed: It is Always a Bad Idea to . . . .

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In my 30 plus years of practice representing physicians, dentists, nurses and health care professionals, I have defended clients involved in many different situations. Several of these seem to be problem  areas which we see repeatedly. The following is a list of those problems which it would seem to be common sense for a physician or other health care professional to avoid doing.

I can assure you, it is always a bad idea for a physician or other health care professional to:

1. Write a prescription for any medication for yourself.

2. Start a romantic relationship with a patient.

3. Take someone else’s prescription medication, ever.

4. Write a prescription for or treat a patient, especially a family member, for a condition outside the scope of her specialty (e.g., a dentist prescribing antibiotics to her children to treat a cold;  a pediatrician prescribing pain medications for an adult;  a dentist writing a prescription for pain medications for a patient’s back pain;  an OB/GYN prescribing antidepressants for a male; podiatrist writing prescriptions for narcotics to treat back pain).
5. Write any prescription for or treat any patient who is in another state when the physician or health professional is not licensed in that state.

6. Treat or prescribe for any spouse, other family member, friend or colleague, without opening a medical record and fully documenting the treatment or prescription, as you would for any other patient.

7. Hire a patient to work for you in your office or, especially, allow a patient to “volunteer” to work in your office.

8. Pre-sign blank prescriptions for your physician assistant, ARNP, medical assistant, nurse, receptionist, or anyone else, to complete later, or have pre-signed blank prescriptions in your office.

9. Seek psychotherapy or drug/alcohol abuse treatment with a physician or health professional in your own medical group, institution or the staff of your own hospital.

10. Add to, alter or change any medical/dental record entry after you know there may be a claim, investigation or litigation involving it.

11. For a mental health professional (psychiatrist, psychologist, mental health counselor,  social worker, psychiatric nurse practitioner) to have any type of social relationship with a current patient.

12. Take and use your own drug samples provided by pharmaceutical companies.

13. Go into a hospital where you do not have clinical privileges and treat or “assist” in treating a patient there, even if it is your own patient.

14. Have a sexual relationship ( including “sexting” or “telephone sex”) with a patient or patient’s immediate family member.

These are actual examples from cases in which I have had to represent licensed health professionals in defending their licenses and attempting to keep their jobs.  For each of the above, there have been more than one.

Avoid doing these things and you will be avoiding some of the major actions including charges and an investigation by your state licensing board, the Drug Enforcement Administration (DEA), your national certification board, any facility at which you have privileges and other law enforcement agencies.

For more information on things that could be harmful to your professional license, click here to read one of my prior blogs.

To learn more about how The Health Law Firm can assist you, click here to visit our website’s areas of practice page.

Click here to view a powerpoint presentation from a previous lecture on how to protect your license.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

KeyWords: Items health care professionals should avoid doing, legal representation for investigation by state licensing board, legal representation for Drug Enforcement Administration (DEA) investigations, DEA investigation defense attorney, legal representation for Board investigations, legal representation for Board complaints, legal representation for licensure revocation, license defense attorney, licensure defense for health care professionals, legal representation for health professionals, legal representation for DOH investigations, DOH defense attorney, legal representation for DOH complaints, legal representation for disciplinary actions,  legal representation for health professionals, legal representation for doctors, Legal counsel for licensure issues, licensure defense attorney, legal representation for suspended or revoked license, legal representation for adverse disciplinary actions, administrative defense attorney, legal representation for investigations and complaints, legal representation for administrative hearings, complaint investigation defense attorney for health care professionals, appeals (and variations on appeal ) of adverse license action, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2018 The Health Law Firm. All rights reserved.

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CMS Approves Five Year Extension of Florida Medicaid Managed Care Demonstration

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 3, 2017, the Centers for Medicare & Medicaid Services (CMS) approved a five-year extension of Florida’s Managed Medical Assistance (MMA) section 1115 demonstration. It allows the state to operate a capitated Medicaid managed care program and a low-income pool (LIP) to provide continuing support for the safety net providers that furnish charity care to the uninsured.

CMS touted the approval as part of its efforts to give states more flexibility to design and tailor Medicaid programs to their specific needs.

Tools For More Effective Medicaid Programs.

This demonstration provides the state with new tools to help it meet the following goals:

• Provides necessary financial support to public teaching hospitals, children’s hospitals, and other hospitals for the care they furnish to low-income uninsured Floridians; and

• Strengthens the breadth of access to and quality of providers participating in Florida’s managed care program, including care provided by many Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC).

“This program gives Florida the ability to care for its most vulnerable and at-risk citizens. Its renewal also provides flexibility to use the funds in a way that meets the unique needs of the State while reducing burden by eliminating duplicative reporting and documentation requirements,” said CMS Administrator Seema Verma. “This extension has a positive and direct impact on people’s lives and their ability to access care. Florida’s program offers an innovative and realistic pathway to tackling some of Medicaid’s biggest challenges.”

These changes are consistent with CMS’s commitment to lessen or remove inappropriately burdensome and/or duplicative state reporting activities.

For more information, click here.

To read the press release in full from CMS, click here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now. 

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at http://www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

AHLA Weekly. “CMS Approves Florida Medicaid Demonstration Under New Era of State Flexibility.” The American Health Lawyers Association. (August 3, 2017). Web.

“CMS Approves Florida Medicaid Demonstration Under New Era of State Flexibility.” CMS.gov. (August 3, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

KeyWords: Florida’s Managed Medical Assistance (MMA) program, the Centers for Medicare and Medicaid Services (CMS), legal representation for CMS issues, legal representation for MMA issues, Medicaid and Medicare defense attorney, legal representation for Medicare and Medicaid issues, Florida Medicaid attorney, legal representation for Medicaid investigations, legal representation for Medicaid and Medicare investigations, legal representation for Medicaid programs, legal representation for Florida’s managed care program, health law defense attorney, legal representation for health care professionals, Florida health law attorneys, The Health Law Firm, reviews of The Health Law Firm, reviews of The Health Law Firm attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.

Jury Awards $4.4 Million To Chicago Anesthesiologist Defrauded By Business Associate

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 9, 2017, a jury in Illinois awarded a Chicago-area anesthesiologist nearly $4.4 million. The jury unanimously agreed that his business associate defrauded him on a revenue sharing agreement and fraudulently reported his earnings to the Internal Revenue Service (IRS).

The jury found that Dr. Martin R. Hall, owner of Keystone Orthopedic Specialists SC (Keystone), stuck Dr. Nicholas Angelopoulos with unwarranted expenses throughout the course of their business dealings. The jury ultimately agreed in favor of Dr. Angelopoulos on all five counts, including two breach of contract counts, breach of fiduciary duty, fraud and violation of IRS code.

 

A Sour Business Deal.

According to Dr. Angelopoulos, when he began to question Dr. Hall’s business expenditures, Dr. Hall would not provide sufficient documentation for the purchases. Dr. Angelopoulos also claimed he was not receiving credit for all of his billings. Additionally, over the course of their three-year working relationship, Dr. Angelopoulos claimed that Dr. Hall made payments to his family members, including his wife and his sister, without disclosing it to the other business associates.

In 2008 after Dr. Angelopoulos left Keystone, Dr. Hall came to him with a hand-written tabulation of more than $150,000 Dr. Angelopoulos allegedly owed to Keystone. Dr. Angelopoulos rejected the amount saying it was false.

Fraudulent Reports to the IRS.

In response to the rejection, Dr. Hall then allegedly reported a payment of $159,577.45 to Dr. Angelopoulos in tax documents filed with the IRS. Dr. Hall claimed that it was for the alleged outstanding debt plus an alleged bonus, which Dr. Angelopoulos claimed he never received, according to court documents. Because of this, in 2011 the IRS came after Dr. Angelopoulos for taxes on Dr. Hall’s reported payment, settling the taxable amount at about $120,000.

In the end, jurors agreed with Dr. Angelopoulos that these numbers were inaccurately reported by Dr. Hill in the first place. Additionally, the jury rejected Dr. Hall’s counterclaim arguing that Dr. Angelopoulos still owed him the money.

To view the court document’s in this case, click here.

To read an article I wrote on how to prevent employee embezzlement which was featured in Medical Economics, click here.

To learn more about complex business litigation and examples of how The Health Law Firm can help you, click here.

 

Contact Health Law Attorneys Experienced in Business Transactions and Contracts.

At the Health Law Firm we provide legal services for physicians, dentists, and the owners of medical practices. We represent owners, shareholders and employees in shareholder disputes, contract litigation, complex healthcare transactions and complex business litigation. This includes psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We also represent health facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

The services we provide include disputes with health insurers, defense of audits, litigation of overpayment demands, reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings. Our attorneys litigate in state courts, federal courts, state administrative hearings and federal administrative hearings. We represent plaintiffs and defendants in complex litigation matters.

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Source:

Simpson, Dave. “Jury Awards $4.4M To Doc Defrauded By Associate.” Law360. (June 7, 2017). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Florida health law attorney, medical practice shareholder dispute lawyer, partnership break-up attorney, health law defense attorney, complex business litigation attorney, legal representation for contract negotiations, legal representation for health mergers and acquisitions, DOJ Antitrust Division lawyer, legal representation for complex business litigation, legal representation for contract disputes, legal representation for complex health care litigation, health care litigation attorney, complex litigation lawyer, medical practice ownership litigation, medical clinic employemnt dispute lawyer, legal counsel for health care business transactions, legal representation for health care contracts, contract negotiations lawyer, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Responding to a Medicaid Audit: Important Tips You Should Know

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), Bureau of Medicaid Program Integrity, is the Florida agency responsible for routine audits of Medicaid health care providers. Each state has a similar state agency, though it may have a different name.  The agency’s job is to ensure that the Medicaid Program was properly billed for services. Health care professionals receiving large payments from Medicaid or who practice in areas that typically see the most abuse or fraudulent billings, are the ones most likely to be audited.  These include pediatricians, Ob/Gyns, family practice physicians and pediatric dentists.

A different state agency that may also conduct Medicaid audits is the state Medicaid Fraud Control Unit (MFCU).  However, by definition, the MFCU is investigating allegations that there is substantial fraud going on.  You should know that if you are contacted by the MFCU, this is a very serious matter.  This is not a routine audit.
However, on the “routine” audits conducted by the Medica agency, the Medicaid audit usually requests information in a questionnaire that the medical practice is required to complete. Additionally, copies of medical records (including x-rays and other diagnostic studies) on the list of Medicaid patients selected for the audit.

If AHCA (or the state Medicaid agency) determines that Medicaid overpaid for services, it will use a complex mathematical extrapolation formula to determine the repayment amount. The amount of the repayment to the Medicaid Program can be considerably greater than (30 to 100 times as much as) the actual amount of overpayment disclosed by the sample of records audited. Additionally, fines and penalties can be added by the Medicaid Program. However, you can eliminate or reduce the amount of any such repayment by actions taken both before and during the Medicaid audit.

 

General Practice Tips:
There are various ways to manage your practice that will help you in the event that you are selected for a Medicaid Audit.

1. Every patient record entry should be clearly dated and signed or initialed by the provider. Make sure this is always done.

2. When documenting in the patient’s record, make sure that you document exactly what services were needed and completed in order to support what was billed to Medicaid.

3. Communicate with the person responsible for your billing so that the actual services provided are billed for. Do not bill in advance for anticipated services needed as indicated in the appointment calendar or on a treatment plan.

4. Keep the patient records organized and ready for copying if necessary. Use only one sided documents and securely fasten small forms (prescriptions, telephone memos, small sticky notes) onto 8-1/2″ by 11″ paper. Scan all such documents into the patient record if using an electronic health record (EHR).

5. Services provided by a physician who is not enrolled in the Medicaid Program to a Medicaid patient may not be billed to or paid by the Medicaid Program. Therefore, never allow any other physician associated with your practice who is not enrolled as a Medicaid provider to provide services to Medicaid patients. Do not allow a new physician coming into your practice to treat Medicaid patients until he or she actually has received his or her Medicaid provider number. The group may not bill for the services nor may another physician bill for the services.

6. Ensure that all health care professionals’ licenses and permits are kept up to date. Ensure that all x-ray, clinical, lab and diagnostic equipment is permitted and kept up to date. Ensure that any CLIA license or exemption certificate is correct and kept up to date. Services billed by unlicensed personnel or services provided by improperly licensed facilities may not be paid by the Medicaid Program.

7. Use only standard abbreviations in your medical records, documentation, orders, and reports. While an abbreviation may seem common to you or your practice, if it is not a universally accepted abbreviation, the auditors may not recognize it.

8. Make sure all records are timely made, accurate and legible. Safeguard them and never let the original leave your office. Illegible records are treated as a non-record, and payment completely disallowed for an illegible note or order. A missing record, x-ray or chart entry will result in a complete repayment being directed for those services.

The Medicaid Audit:

If you are being audited, AHCA will send you a letter notifying you of the audit. AHCA will also supply you with a list of patients to be sampled a standard sample will include a list of anywhere from 30 to 150 patient names, depending on the size of the practice. Regular audits routinely request 30 to 50 patient records. The audit letter will also include a questionnaire to be completed (Medicaid Provider Questionnaire) and a “Certification of Completeness of Records” form to complete and return with the copies of the patient records. (Please note: this will be used against you in the future if you attempt to add to or supplement the copies of the records you provided).

It is crucial that you retain the services of an expert consultant or experienced health care attorney in correctly and accurately completing the questionnaire. The letter will also request that you provide copies of the patient records for the list of patients included with the letter. You will only be given a short time to provide these documents.

1. When receiving a notice of a Medicaid audit, time is of the essence. Be sure to calendar the date that the records need to be in the AHCA office and have the records there by that date. Note: the due date is not the last date on which you can mail the records but rather is the date that the records must be received at AHCA.

2. Obtain and review a copy of the claims you submitted and what Medicaid has paid on each of the patients being audited. This information can be found in the Medicaid portal, in your billing system, or in the Explanation of Benefits. Compare this information to the medical records to see if any issues may arise when AHCA reviews the records. (Keep this for your use, do not provide it as part of the audit records).

3. Provide a complete copy of the entire record, not just the parts from the period of time covered by the audit. Remember that other physician records obtained as history, including reports and consultations should be included. Consent forms, medical history questionnaires, histories, physicals, and other physicians’ orders, may be a crucial part of the record.

4. If you suspect that an issue may arise with a particular patient, prepare a separate explanation to submit with the patient’s file. AHCA will have an expert review the records, so an explanation in advance will help the expert to assess if there is in fact an issue. Any explanatory notes or other explanations should be clearly labeled as such and dated as of the date actually prepared, so there is no confusion as to whether or not it was part of the original record.

5. If your practice involves taking x-rays or using other diagnostic studies, these procedures are part of the patient’s record. If the x-rays are digital, they can be submitted on a compact disc. Be sure to include the number of x-rays on the compact discs in the Certification of Completeness of Records.
6. Complete the Medicaid Provider Questionnaire in its entirety to send with the patient records. Do not leave any section blank. Use “not applicable” or “none” if necessary. Attach all required documents. Consult with an experienced health law attorney to assist in completing the form.

To learn more about the Medicaid audit process and how The Health Law Firm can assist you, click here to watch our short video blog.

Don’t Wait Until It’s Too Late, Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
If you or your practice has been sent notice of a Medicaid or Medicare audit, please contact us at (407) 331-6620 or (850) 439-1001 or visit our website at www.TheHealthLawFirm.com for more information.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

KeyWords: Legal representation for Medicaid audits, Medicaid audit defense attorney, health care fraud defense attorney, health care fraud investigation defense attorney, legal representation for health care fraud investigation, legal representation for health care fraud, Medicaid fraud defense attorney, legal representation for Medicaid fraud, legal representation for fraudulent billing, legal representation for submitting false claims to the government, legal representation for overbilling, health care fraud attorney, The Health Law Firm, reviews of The Health Law Firm attorneys, reviews of The Health Law Firm
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.

Florida Gov. Rick Scott Makes Changes to Florida Impaired Practitioners Program

indest1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On May 31, 2017, Florida Governor, Rick Scott, signed into law House Bill 229 (Ch. 2017-41, Laws of Florida), which made changes to the statutory basis for Florida’s impaired practitioner programs. The impaired practitioner program for nurses in Florida is the Intervention Project for Nurses (IPN), which is a for-profit corporation, The impaired practitioner program for doctors, dentists, pharmacists, optometrists, and all other licensed health professionals is the Professionals Resource Network (PRN), a non-profit corporation.

The program, as envisioned in the statute, is designed to assist health care practitioners who are impaired as a result of the misuse or abuse of alcohol or drugs, or of a mental or physical condition, which could affect the ability to practice with skill and safety.

Revisions to the Program.

The new law requires DOH to establish terms and conditions of the program by contract, provides contract terms, requires DOH to refer practitioners to consultants and revises grounds for refusing to issue or renew license, certificate, or registration in health care professions.

A significant change in the program involved a licensee’s duty to report colleagues that have or are suspected of having an impairment. The new law creates an exception to the mandatory reporting of an impairment to the DOH. The new revision will allow a licensee who knows that a person is unable to practice with reasonable skill and safety due to an impairment, to report such information to the consultant, rather than DOH. Both the core licensure statute and individual practice acts are amended to include this language.

Be sure to check Florida’s DOH website regularly for news and updates, here.

To learn more about how The Health Law Firm can help you with matters involving the DOH, click here.

If You Are Instructed to Contact IPN or PRN, Call an Attorney First.

If you are ever instructed by your employer or anyone else to report yourself to the Intervention Project for Nurses (IPN) or to the Professionals Resource Network (PRN), consult with an experienced health law attorney first. There are many problems that you can avoid by having good legal advice before you make a stupid mistake. We are often consulted and retained by clients when after they have made mistakes in talking to the wrong people about the wrong things and are in a situation they could have avoided.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers. We represent impaired physicians and other health professionals in Professional Resource Network (PRN) and disruptive physician matters.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:

“Changes to Florida Reporting for Impaired Practitioners.” Holland & Knight LLP. (June 7, 2017). Web.

Mckown, Mia. “Changes to Florida Reporting for Impaired Practitioners.” Lexology. (June 7, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for impaired physicians, Legal representation for Department of Health (DOH) investigations, Intervention Project for Nurses (IPN) attorney, Professionals Resource Network (PRN) defense legal counsel, DOH investigation defense attorney, legal representation for investigations against health care professionals, legal representation for Florida DOH investigations, Florida DOH representation, DOH complaint defense, legal representation for DOH complaint, Florida impaired practitioners program, legal representation for PRN matters, legal representation for IPN matters, legal representation for disruptive physician issues, health law defense attorney, legal representation for health care professionals, changes to Florida impaired practitioners program, legal representation for health care investigations, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

 

Medical Students, Interns & Residents Beware: A Finding of “Irregular Behavior” Can Ruin Your Medical Career Before it Starts

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A medical student, intern or resident may receive a letter from the National Board of Medical Examiners (NBME), United States Medical Licensee Examination (USMLE) Secretariat advising them that they are suspected of “irregular behavior” on a Step examination. In the case of graduates of foreign medical schools, this will be a letter from the Educational Commission for Foreign Medical Graduates (ECFMG). Although “irregular behavior” is not the same thing as “cheating,” it is often thought of as the same by medical school officials and residency program directors.

A notice of irregular behavior may delay your entry into a residency program, your graduation from medical school and your potential job opportunities. Your examination scores will be held up while the matter is investigated until a Committee review or hearing can be held.

It is imperative that anyone accused of irregular behavior immediately consult with legal counsel experienced in such matters. At The Health Law Firm, we have represented a number of medical students, interns and residents in hearings on irregular behavior and we have consulted with many before on these matters.

Don’t Listen to Bad Advice.

The following are examples of erroneous advice we have heard was given to those accused of irregular behavior:

1. You shouldn’t have a lawyer represent you in such matters because this will make the Committee angry at you.

2. You don’t need a lawyer because you can just explain it yourself.

3. You just write a statement and explain it; the Committee will understand and find in your favor.

4. You do not need to request a hearing on it because if you submit documents, the Committee will review them, find in your favor and no hearing will be necessary.

5. If you request a hearing on the matter, you do not need to attend it in person.

6. If you request a hearing, an attorney is not allowed to represent you at the hearing.

7. You should not worry about the Committee finding against you because you can always appeal the finding or sue in court.

The above advice is wrong. The only advice you should listen to is the advice of an attorney who is experienced in handling matters of irregular behavior.

The Importance of Retaining Experienced Legal Defense.

The biggest problem faced by an individual accused of irregular behavior who does have a valid defense is to concisely and adequately explain the situation. Additionally, you must produce evidence that supports what you are saying.

Someone who is not trained in the legal profession and who is not familiar with such hearings will be unfamiliar with the process even though such hearings are not as formal as court hearings. Additionally, it is easy for a non-lawyer who is not familiar with the rules of the USMLE to fail to address those concerns and get side tracked on irrelevant matters.

Additionally, documents, statements, affidavits, expert witness reports and other documents presented to the Committee as evidence should be well organized, indexed, with a table of contents, pages numbered and summarized. This will better present an organized, easily understood defense. Sending in a few stray documents with no organization or explanation how the documents relate to the issues can be far less than effective.
Consequences of an Irregular Behavior Finding.

If a finding of irregular behavior is made against you, then this usually means that your best score is voided and you must retake it. The Committee may require you to wait a year or more to retake the examination. This can prevent you from obtaining or entering a residency program or it may delay you from graduating. Furthermore, the notation that you were found to have committed irregular behavior will be placed on your Step exam transcript. This will be reported out when your test scores are reported.

As indicated above, many medical decision makers view this as similar to cheating. It may disqualify you for many jobs or residency programs that you would otherwise be considered for.

If the time and money you have spent on your medical career is valued by you, you will act promptly to retain legal counsel experienced in USMLE hearings and procedures to represent you. You wouldn’t perform surgery on yourself. You shouldn’t attempt to represent yourself in such legal matters.

The takeaway message is that retaining an attorney to represent you against irregular behavior allegations could be the difference between a clear record and a mark that will follow you for the rest of your career. Don’t risk jeopardizing your future as a healthcare practitioner. Consult with an attorney as soon as you receive notice of allegations against you regarding irregular behavior.

To learn more on the repercussions of findings of irregular behavior, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Matters of Irregular Behavior Today.

The attorneys of The Health Law Firm provide legal representation to medical students, residents, interns and fellows in irregular behavior allegations, USMLE issues, academic disputes, graduate medical education (GME) hearings, contract negotiations, license applications, board certification applications and hearings, credential hearings, and civil and administrative litigations.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for allegations of irregular behavior, legal representation for USMLE investigations, National Board of Medical Examiners (NBME), irregular behavior defense attorney, legal representation for medical students, legal representation for medical residents, United States Medical Licensing Examination (USMLE), Educational Commission for Foreign Medical Graduates (ECFMG), legal representation for USMLE hearings , legal counsel for USMLE appeals, health law defense attorney, ECFMG defense counsel, ECFMG legal representation, ECFMG hearing attorney, medical student attorney, medical resident lawyer, medical intern attorney, legal representation for civil proceeding, legal representation for criminal proceeding, legal representation for administrative proceeding, medical administrative hearings defense attorney, The Health Law Firm, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, USMLE Committee for Individualized Review (CIR) hearing attorney, ECFMG Committee for Individualized Review (CIR) hearing lawyer

“The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., and Florida professional service corporation, since 1999, and is also a registered service mark. Copyright © 2017 The Health Law Firm. All rights reserved.

Jury Convicts Doctor and Medical Billing Company Owner for $28 Million Medicare Fraud Scheme

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On May 1, 2017, a federal jury in Michigan found a Detroit-area doctor and owner of a medical billing company guilty of perpetrating a $28 million health care fraud scheme. The scheme involved billing Medicare for pain treatments that weren’t actually provided, the U.S. Department of Justice (DOJ) said.

Health Care Fraud Scheme.

Dr. Johnny Trotter and Elaine Lovett were both convicted after a four-week jury trial on one count of conspiracy to commit health care and wire fraud and three counts of health care fraud. In addition to the fraud scheme, both Trotter and Lovett also worked to dodge Medicare’s investigation into Trotter, according to the DOJ.

Evidence at the trial showed that between May 2008 and May 2014, both Trotter and Lovett fraudulently billed for services that were never provided. These services were predominantly nerve block injections, which treat pain by numbing groups of nerves.

In 2009, Medicare grew suspicious and began to require that claims submitted by Trotter satisfy a medical review prior to payment pre-payment review). As a result, both Trotter and Lovett conspired to dodge this investigation by starting fake medical centers, according to the prosecution said.

Trotter and Lovett attempted to hide their involvement by recruiting family members and employees to serve as “straw owners” of the companies. Meanwhile, the two fraudsters continued receiving payment for services that weren’t provided, the government said.

To learn more about health care fraud and the repercussions of Medicare fraud, click here to read one of my prior blogs.

Watch our short video blog on Medicare fraud and the audit process here.

Contact a Health Care Attorney Experienced in the Representation of Medicare and Medicaid Fraud.

The Health Law Firm and its attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicare and Medicare investigations, audits and recovery actions.

To contact the Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Kennedy, John. “Jury Convicts 2 Over $28M Medicare Pain Treatment Fraud.” Law360. (May 1, 2017). Web.

“Jury Convicts 2 Over $28M Medicare Pain Treatment Fraud.” Lexis Nexis. (May 1. 2017). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.